Intestinal fistulas

An intestinal fistula is a communication between the gut and another epithelial surface. Primary disease of the gut (Crohn’s disease, diverticular disease, colorectal cancer, radiation enteritis) can all lead to fistula formation which then requires resection of the diseased bowel to close the fistula. Injury (usually iatrogenic) produces a fistula through normal gut and if circumstances are favourable such an injury can close spontaneously. Some postoperative fistulae will not close spontaneously and they require a systematic approach that eliminates sepsis (S), restores nutrition (N), determines anatomy (A) and leads to a closure procedure (P) - SNAP. Sound abdominal closure is an essential feature of surgery to close an intestinal fistula.